@article {Lena1389, author = {Enrico Lena and Jos{\'e} Aquino-Esperanza and Josefina L{\'o}pez-Aguilar and Rudys Magrans and Candelaria de Haro and Leonardo Sarlabous and Neus L{\'o}pez and Jaume Montany{\`a} and Montserrat Ru{\'e} and Robert M Kacmarek and Umberto Lucangelo and Rafael Fern{\'a}ndez and Paolo Pelosi and Llu{\'\i}s Blanch and for the Asynchronies in the Intensive Care Unit (ASYNICU) Group}, title = {Longitudinal Changes in Patient-Ventilator Asynchronies and Respiratory System Mechanics Before and After Tracheostomy}, volume = {66}, number = {9}, pages = {1389--1397}, year = {2021}, doi = {10.4187/respcare.08824}, publisher = {Respiratory Care}, abstract = {BACKGROUND: This was a pilot study to analyze the effects of tracheostomy on patient-ventilator asynchronies and respiratory system mechanics. Data were extracted from an ongoing prospective, real-world database that stores continuous output from ventilators and bedside monitors. Twenty adult subjects were on mechanical ventilation and were tracheostomized during an ICU stay: 55\% were admitted to the ICU for respiratory failure and 35\% for neurologic conditions; the median duration of mechanical ventilation before tracheostomy was 12 d; and the median duration of mechanical ventilation was 16 d.METHODS: We compared patient-ventilator asynchronies (the overall asynchrony index and the rates of specific asynchronies) and respiratory system mechanics (respiratory-system compliance and airway resistance) during the 24 h before tracheostomy versus the 24 h after tracheostomy. We analyzed possible differences in these variables among the subjects who underwent surgical versus percutaneous tracheostomy. To compare longitudinal changes in the variables, we used linear mixed-effects models for repeated measures along time in different observation periods. A total of 920 h of mechanical ventilation were analyzed.RESULTS: Respiratory mechanics and asynchronies did not differ significantly between the 24-h periods before and after tracheostomy: compliance of the respiratory system median (IQR) (47.9 [41.3 {\textendash} 54.6] mL/cm H2O vs 47.6 [40.9 {\textendash} 54.3] mL/cm H2O; P = .94), airway resistance (9.3 [7.5 {\textendash} 11.1] cm H2O/L/s vs 7.0 [5.2 {\textendash} 8.8] cm H2O/L/s; P = .07), asynchrony index (2.0\% [1.1 {\textendash} 3.6\%] vs 4.1\% [2.3 {\textendash} 7.6\%]; P = .09), ineffective expiratory efforts (0.9\% [0.4 {\textendash} 1.8\%] vs 2.2\% [1.0 {\textendash} 4.4\%]; P = .08), double cycling (0.5\% [0.3 {\textendash} 1.0\%] vs 0.9\% [0.5 {\textendash} 1.9\%]; P = .24), and percentage of air trapping (7.6\% [4.2 {\textendash} 13.8\%] vs 10.6\% [5.9 {\textendash} 19.2\%]; P = .43). No differences in respiratory mechanics or patient-ventilator asynchronies were observed between percutaneous and surgical procedures.CONCLUSIONS: Tracheostomy did not affect patient-ventilator asynchronies or respiratory mechanics within 24 h before and after the procedure}, issn = {0020-1324}, URL = {https://rc.rcjournal.com/content/66/9/1389}, eprint = {https://rc.rcjournal.com/content/66/9/1389.full.pdf}, journal = {Respiratory Care} }